29 October 2012

Richard from TCA asked if I wanted to try a new elbow injury treatment device that TCA are now retailing in the UK called the Armaid. TCA have started retailing it after seeing some impressive results on chronic golfer’s elbow. I must say, it’s a cleverly designed piece of kit and performs it’s task extremely well. But does it work? The answer, it seems, is ‘sort of’. Let’s go through some details.

How the Armaid works is pretty simple. If you want to see the details, watch the video below. Basically it provides an easy and effective was to give the flexor or extensor tendons and muscles of the forearm a good massage of various intensities. It’s very easy to use and control. Administering a good session of massage either as a therapist or by yourself is actually quite a difficult thing to do. It’s pretty hard on the thumbs, wrists, and elbows of the arm actually applying the treatment. So it can actually cause injuries as well as help them! Apart from that, your massaging arm gets tired before you’ve done enough.

So the first thing to say is that if I did want to perform regular massage on elbow epicondylitis, I’d definitely get one of these and use it.

This leads to the broader question of whether massage is actually useful for healing these injuries. That is less simple to answer. To attack the question, it’s first necessary to be clear that injury treatments fall into 2 broad categories; those that only reduce symptoms by reducing pain signals and those that reduce symptoms by actually altering the health of the affected tissue.

Obviously the latter is more effective in the long term and the more desirable type of treatment. At the moment, it seems like eccentric exercise therapy together with various other interventions (postural, training, technique, tactics) are effective in most cases for eliminating golfers and tennis elbow. Most people fail to recover because they don’t do the eccentrics, don’t do them properly and don’t make the necessary changes in their climbing to remove the underlying causes. So the condition becomes chronic.

It has been suggested that massage of various types can also be a useful treatment, either by directly increasing nutrient delivery to the degenerated tendons, breaking up disorganised scar tissue or adhesions, or by an analgesic effect. Deep friction massage is one particular massage technique that is aimed at breaking up adhesions in the tendon itself. It's not really known if it has any real effects beyond short term pain relief. DFM uses aggressive massage across the fibres rather than in line with them. I'm not sure if the Armaid could be used effectively for DFM?Pain signals by various types of massage might be reduced in several ways such as breaking up the ‘neovessels’ packed with pain receptors that grow in diseased tendons, providing a ‘counter irritant’ that down-regulates pain sensation by the brain, or by releasing painful trigger points in the muscle belly. There is evidence that all of these aspects of massage help the injury feel less painful.

Analgesic effects are nice, but may not actually help the tendon heal directly. So there is an argument for not wasting your time on these and focusing on the treatments that will improve the strength of the tendon tissue. And this is where the rub of the debate is. Massage may not improve tissue health directly, but the pain relief may be worth it if it allows you to complete the therapeutic exercises that do.

So, I would use try this device if I had bad enough elbows that I was unable to complete a rigorous program of daily eccentrics (priority number 1), and do some climbing too. To use it as a pain reliever to just keep climbing and not address the underlying causes and tissue damage would be a very risky strategy. It’s true that pain relief allowing climbing to resume does sometimes allow spontaneous healing. I’d say this is more likely if the original condition was caused by a sudden increase in loading such as resuming climbing after a bit of time off. However, tendinosis of the elbows tends has a habit of being way more tenacious than that. Don’t underestimate it.

If you feel sure that elbow massage could be useful for you, you could try one of these. It’s most likely to be useful for particularly bad and chronic cases that are reluctant to respond to diligently applied eccentrics and technique changes.

21 October 2012

Recently I spotted a new liquid chalk product called Liquidgrip on the market. I’m always keen to try new things out so asked them for a bottle to try and and review for this blog. It particularly piqued my interested since they make the following claims in their marketing:

“Liquidgrip is the only gripping agent in the world which works by binding to the fatty acids in your skin. This means a single application at the start of your session will last for hours without reapplying. Unlike regular chalk and liquid chalk, Liquidgrip leaves NO marks at all on clothing or equipment and is even anti-bacterial for improved hygiene. The harder you work, the harder Liquid grip works. It even works in the rain and isn’t affected by sweat.”

All this sounds pretty interesting. On trying it, it does indeed seem a little different to standard liquid chalk, with more longevity and less obvious deposit on the holds. Crucially, the grip itself feels different. On your skin it feels sticky. So far so good. On the rock, I had variable results. I tried it outdoors at first and initially rather liked it. Later I felt that it worked well on some types of holds and not any better than normal chalk at other times. Indoors, I didn’t get on so well and found it ‘rolled’ off my finger skin and didn’t improve the friction. However, I have really sweaty hands, so I’m a tough customer to please in that environment.

Overall, it wasn’t for me. I felt it filled the fingerprint ‘tread’ too much. The stickiness was good but although the product stays on your skin reasonably well, the stickiness doesn’t seem to last all that well. I was obviously keen to find out more about where that stickiness comes from. I asked the UK distributors but they couldn’t tell me. The ingredients list on the bottle is exactly the same as standard liquid chalk (chalk, alcohol, thickener). However, on the american liquidgrip site it mentions having rosin in it. Rosin is commonly used by weightlifters for grip. Presumably the sticky feeling comes from the rosin? I doubt that in this form it would leave any residue on the rock, but who knows?[UPDATE] Liquidgrip clarified that there is a small amount of Rosin (less than 5%) in the product and they reassure that there is no transference to surfaces although didn't say how this was tested.

Some people might like it for climbing more than I did. Although I didn’t personally prefer it to standard chalk for climbing, I probably would use it in a weights gym, where you wouldn’t get away with using loose chalk. I’d also use it if I had a fingerboard in a room at home I didn’t want to cover in chalk dust.[SECOND UPDATE] Here is a nice review of the product by Spenser who tested it systematically and found evidence of some residue left on the rock compared to normal chalk. It's not something I often think about here in Scotland since almost all my routes are first ascents and some of them go over a decade without a repeat. However, in popular areas this review is a reminder that we need to be very careful how we use the natural resource - it can get trashed within the space of a few short years. It's seriously not good and it's unnecessary.